Provider Demographics
NPI:1932922986
Name:NASH, SHAUNTRICE
Entity type:Individual
Prefix:
First Name:SHAUNTRICE
Middle Name:
Last Name:NASH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 CAMINO REAL TRL
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-5977
Mailing Address - Country:US
Mailing Address - Phone:469-230-8864
Mailing Address - Fax:
Practice Address - Street 1:3808 CAMINO REAL TRL
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-5977
Practice Address - Country:US
Practice Address - Phone:469-230-8864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR0243202C00000X
246RP1900X, 291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical Examiner
No246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy